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Health, Education, Recreation 



MEDICAL INSPECTION LEGIS- 
LATION 

Compiled by 

LEONARD P. AYRES, Ph.D. 




Department of Child Hygiene 
Russell Sage Foundation 

400 Metropolitan Tower, New York City 



Price 20 Cents 



Contents 

PAGE 

Map •. 2 

Medical Inspection Legislation in America 5 

Principal Features of Laws 6 

Abstract of Laws and Regulations 7 

Provisions New Laws Should Include 1 1 

California I2 

Colorado 14 

Connecticut 15 

District of Columbia 17 

Indiana 28 

Louisiana 30 

Maine 33 

Massachusetts 35 

Minnesota 40 

New Jersey 42 

New York 43 

North Dakota 44 

Ohio 44 

Pennsylvania 45 

Utah 48 

Vermont 49 

Virginia 49 

Washington 50 

West Virginia 50 



Medical Inspection Legislation in 
America 

The first state law providing for the medical inspection of school 
children appears to have been passed by Connecticut in 1899. 
It did not provide for the complete sort of inspection now carried 
on in many cities and states, but only for the testing of eyesight 
by teachers every three years. Complete medical inspection 
with examinations for the detection of physical defects was first 
provided for by state enactment in the permissive law of New 
Jersey passed in 1903. This was followed by the mandatory 
law of Massachusetts in 1906, which has been several times 
amended, and which has served as the basis for a majority of the 
bills which have since been presented in other state legislatures. 

At the present time (May, 191 1), six states have mandatory 
laws, ten have permissive ones, and in two states and the District 
of Columbia medical inspection is carried on under regulations 
promulgated by the boards of health and having the force of 
law. The fact that the Massachusetts statute is the oldest of 
the laws now in force shows that the whole body of legislative 
enactments which crystallize the views, beliefs and results of 
experience of educators and physicians, is of distinctly recent 
origin. 

Nevertheless, the past five years have furnished a large body 
of experience under varying conditions and in widely separated 
localities, and the lessons of this experience can be read in the 
substantial agreement of a majority of the laws in several salient 
features. This is graphically shown by the tabular presentation 
of the principal features of the different laws and regulations 
printed on page 6. 

On four points there is substantial agreement. The first is 
that the administration of the provisions of the laws is placed in 
the hands of the school authorities. 'The second, third and 
fourth are respectively placing in the hands of school physicians 
the inspection for contagious diseases, the physical examin- 
ations, and the inspection of teachers, janitors and buildings. 
In six cases provision is made for testing of vision and hearing . 
by the teachers. 

A clear idea of the principal provisions of the different laws 
may be gained by reading the abstract beginning on page 7. 

5 



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Abstract of Laws and Regulations 

1. California 

Adopted 1969 — Permissive — Applies where adopted 

Administered by school authorities 

Provides for health and development supervision of teachers 

and pupils 
Inspectors may be either physicians or educators 

2. Colorado 

Adopted 1909 — Mandatory — Applies to all public schools 

Administered by school authorities 

Teachers or principals test sight, hearing and breathing 
of all pupils annually 

School authorities report to parents mental, moral or physical 
defectiveness discovered 

Enforcement by State Bureau of Child and Animal Protec- 
tion 

3. Connecticut 

Adopted 1907 — Permissive — ^Applies where adopted 
Administered by school authorities 
Physicians inspect children for contagious diseases 
Physicians may examine teachers, janitors and school 

premises 
Physicians conduct sight, hearing and physical examinations 

annually 
Defects reported to parents 
School authorities may appoint school nurses 

4. District of Columbia 

Regulations of Health Officer and Board of Education 
Adopted in present form in 1907 — Mandatory — ^Applies to 

all public schools 
•Administered by health authorities 
Physicians examine for contagious diseases 
Physicians examine sanitary conditions of buildings 
Physicians may examine teachers and janitors 

5. Indiana 

Adopted 191 1 — Permissive — Applies where adopted 
Administered by school authorities 

7 



8 

Physicians inspect children for contagious diseases 

Teachers may test sight and hearing annually 

Physicians conduct physical examinations 

Defects reported to parents 

Not more than 2000 children for one physician 

Compensation of physician not less than $5 for each school 

month 
Physicians may examine teachers, janitors and buildings 
If parents are too poor to provide necessary medical treat- 
ment it shall be paid for from public funds 
Penalty of $5 to $50 for violation of provisions of act 

6. Louisiana 

Adopted 191 1 — Regulations of Sanitary Code of State 
Board of Health having force of law — Mandatory — 
Applies to all public schools 

Administered by school authorities 

Principal of each school makes monthly report on physical 
condition of children and sanitary condition of build- 
ings on blanks furnished by State Board of Health 

Principals and teachers exclude children suffering from 
contagious disease 

7. Maine 

Adopted 1909 — Permissive — Applies to cities and towns of 

less than 40,000 
Administered by school authorities 
No more than 1000 pupils to a physician 
Physicians inspect children for contagious diseases 
Physicians may examine teachers, janitors and buildings 
Tests of sight and hearing annually by teachers or physicians 
Physical examinations annually by physicians 
Defects reported to parents 

8. Massachusetts 

Adopted 1906 — amended 191 o — Mandatory — Applies to all 

public schools 
Administered by school or health authorities 
Physicians inspect children for contagious diseases 
Physicians may examine teachers, janitors and buildings 
Tests of sight and hearing made by teachers annually 
Physicians make physical examinations of children annually 
Defects reported to parents 
Normal schools train students in testing sight and hearing 



Physicians conduct examinations of minors applying for age 
and schooling certificates 

9. Minnesota 

Regulations of Board of Health having force of law- 
Adopted 1910 — Mandatory — Applies to all public schools 
Administered by health authorities 
Physicians examine for contagious diseases 
Physicians may inspect teachers, janitors and buildings 
Physicians conduct physical examinations annually 
Defects reported to parents 
Teachers test sight and hearing annually 
Normal schools train pupils in testing sight and hearing 

10. New Jersey 

Adopted 1909 — Mandatory — ^Applies to all public schools 

Administered by school authorities 

Physicians examine for contagious diseases 

Physicians conduct physical examinations, including sight 
and hearing tests 

Defects reported to parents 

Physicians deliver hygiene lectures to teachers 

Parents and guardians may be proceeded against as dis- 
orderly persons for failure to remove any pathological 
condition which may cause a child's exclusion from 
school 

11. New York 

Adopted 1 910 — Permissive 

Authorizes school authorities to expend school funds for the 
support of medical inspection 

12. North Dakota 

Adopted 191 1 — Permissive — Applies where adopted 
Administered by school authorities 
Physicians conduct physical examinations annually 
Defects reported to parents 

Co-operates with Board of Health to curb contagious 
disease and to secure treatment for indigent children 

13. Ohio 

Adopted 1910 — Permissive — Applies to cities 
Administered by school authorities, but powers may be 

delegated to health authorities 
Physicians inspect children and schools 
School nurses may be employed 



10 

14. Pennsylvania 

Adopted 191 1 — Mandatory in districts of first and second 
class — Permissive in districts of third and fourth class. 
Districts of first class are those of more than 500,000 
population, second class from 30,000 to 500,000, third 
class 5,000 to 30,000, and fourth class less than 5,000 

Administered by school authorities 

Physicians conduct complete physical examinations of 
children annually 

Physicians make sanitary inspection of school premises 
annually 

In districts of fourth class medical inspectors are appointed 
by State Commissioner of Health 

Provision for employment of graduate nurses 

15. Utah 

Adopted 191 1 — Mandatory — Applies to all public schools 

Administered by school authorities 

Teachers or physicians examine all children annually for 

defect of sight or hearing, defective teeth or mouth 

breathing 
Defects reported to parents 

16. Vermont 

Adopted 1 910 — Permissive — Applies where adopted 

Administered by school authorities 

Physicians inspect pupils as provided by rules of State 

Board of Health 
On request, physicians examine pupils of private schools 

17. Virginia 

Adopted 1910 — Permissive — Applies where adopted 
Administered by school authorities 

Authorizes school boards to support systems of medical 
inspection 

18. Washington 

Adopted 1909 — Permissive — Applies to cities of first class 
Administered by school authorities 

Authorizes school boards to appoint medical inspectors who 
shall report monthly on health conditions in each school 

19. West Virginia 

Adopted 191 1 — Mandatory in cities, permissive in country 

districts 
Administered by school authorities 



II 

Physicians inspect children for contagious diseases 
Physicians conduct physical examinations annually 
Physicians, on request of board, report on lighting, ventila- 
tion, etc. 
School nurses may be employed 



Provisions New Laws Should Include 

A comparative study of the provisions of the different laws 
shows that with the added experience gained through knowledge 
of how the older measures have met the test of time, school 
physicians and educators have incorporated in some of the more 
recent measures features which are genuine improvements, and 
which should be provided for in bills for new medical inspection 
acts and amendments of the old ones. The following are the 
features which it would seem ought to be included in bills for 
new medical inspection laws: 

1. A provision that the administration of the system of medical 
inspection shall be in the hands of the school authorities, but 
that they shall have the power to delegate their authority to the 
local health officials, and that in the treatment of cases of con- 
tagious diseases the school and health authorities shall co-operate. 
The principle here involved is that routine medical inspection 
and physical examinations are primarily for insuring the health 
and vitality of the individual child and are preferably handled 
by the school authorities who are charged with his daily care. 
The curbing of epidemics of contagious disease is primarily for 
the protection of the community, and in this the health authorities 
have the right as well as the duty to intervene. Examples of 
such provisions as those suggested are to be found in the laws 
of North Dakota and Ohio. 

2. Provision for inspection by school physicians to detect and 
exclude cases of contagious disease. 

3. Provision for annual examinations of all children by school 
physicians to detect any physical defects which may prevent the 
children from receiving the full benefit of their school work or 
which may require that the work be modified to avoid injury to 



12 

them. This provision should include the requirement that 
parents be notified of any defects discovered. 

4. Provision that annual tests of vision and hearing shall be 
conducted by the teachers. This provision was adopted by 
Massachusetts on the advice of the specialists in these fields and 
its wisdom has been demonstrated by extensive experience in 
that state. 

5. Provision that the school physicians may conduct examina- 
tions of teachers and janitors and shall make regular inspections 
of the buildings, premises and drinking water to insure their 
sanitary condition. 

6. Provision that pupils in Normal Schools shall receive train- 
ing in conducting vision and hearing tests. This requirement 
is found in the Massachusetts law and the Minnesota regulations. 

7. Provision for the employment of school nurses. This is 
provided for in the laws of Connecticut, Ohio, Pennsylvania, and 
West Virginia. 

8. Provision for the enforcement of the law. Such provisions, 
not very well developed, are found in the laws of Colorado, 
Indiana and New Jersey. The nature of the provision must 
vary with local conditions. In states where municipalities re- 
ceive a large part of their school funds from the state, and their 
school policies are consequently largely controlled through the 
State Board of Education, it seems clear that the enforcement of 
the law should be placed in the hands of that body. 



California 

An Act to Provide for Health and Development 

Supervision in the Public Schools of the State 

OF California 

[Approved April 15, 1909] 

The People of the State of California, represented in senate and 
assembly, do enact as follows: 

HEALTH AND DEVELOPMENT SUPERVISION 
Section i . Boards of school trustees and city boards of educa- 
tion are hereby authorized to establish health and development 
supervision in the public schools of this state, and to employ 



13 

an examining staff and other employees necessary to carry on 
said work and to fix the compensation for the same. Whenever 
practicable the examining staff for health and development 
supervision in the public schools of the state shall consist of both 
educators and physicians. 

Sec. 2. The purposes of health and development supervision 
in the public schools of the state are hereby defined as follows: 

1. To secure the correction of developmental and acquired 
defects of both pupils and teachers which interfere with health, 
growth and efifiiciency, by complete physical examination. Said 
examinations shall occur annually or as often as may be deter- 
mined by the board of school trustees or city board of education. 

2. To adjust school activities to health and growth needs and 
to development processes and to attend to all matters pertain- 
ing to school hygiene. 

3. To bring about a special study of mental retardation and 
deviation of pupils in the public schools. 

Sec. 3. The requirements for certification of members of the 
examining staff for health and development supervision in the 
public schools of the state shall be as follows: 

For educators: A life diploma of California of the high school 
or grammar school grade and a health and development certificate 
which shall authorize the holder of such certificate to conduct 
the work authorized by this act, in those grades specified by the 
life diploma held. 

For physicians: A California certificate to practice medicine 
and surgery and a health and development certificate. 

Sec. 4. County or city and county boards of education are 
hereby authorized to grant health and development certificates 
to holders of life diplomas of California of the high school or 
grammar school grade or to holders of California certificates 
to practice medicine and surgery who shall present with such 
life diplomas or with such certificates to practice medicine and 
surgery a recommendation from the state board of education 
certifying special fitness for the work specified in this act. 



14 



Colorado 

An Act Providing for the Exajviination and Care of Chil- 
dren IN THE Public Schools, and Making an Appro- 
priation in Connection Therewith 

[Enacted 1909] 

Be it Enacted hy the General Assembly of the State of Colorado: 

Section i. The State Superintendent of Public Instruction 
shall prepare or cause to be prepared suitable test cards, blanks, 
record books, and other needful appliances and supplies to be 
used in testing the sight, hearing and breathing of pupils in the 
public schools, and the necessary instructions for their use; 
and shall furnish the same free of expense to every public school 
in the State. The teacher or principal in every public school, 
or where there is no principal, the county superintendent, shall, 
during the first month of each school year, test the sight, hearing 
and breathing of all pupils under his charge; such examination 
to be made by observation, without using drugs or instruments, 
and without coming in contact with said child; and keep a 
record of such examinations according to the instructions furnished 
and make a written report of such examinations to the State 
Superintendent of Public Instruction as he may require. 

Sec. 2. Every teacher in the public schools shall report the 
mental, moral and physical defectiveness of any child under 
his supervision, as soon as such defectiveness is apparent, to the 
principal or, where there is no principal, to the county superin- 
tendent. Such principal or county superintendent shall promptly 
notify the parents or guardian of each child found to be defective, 
of the child's defectiveness, and shall recommend to such parents 
or guardian that such child be thoroughly examined as soon as 
possible by a competent physician or surgeon with special refer- 
ence to the eyes, ears, nose, throat, teeth and spine. 

If the parents or guardian of such child shall fail, neglect or 
refuse to have such examination made and treatment begun 
within a reasonable time after such notice has been given, the 
said principal or superintendent shall notify the State Bureau 
of Child and Animal Protection of the facts; Providing, however, 
that whenever it shall be made to appear to the said principal 
or superintendent, upon the written statement of the parent or 
guardian of said child, that such parent or guardian has not 



15 

the necessary funds wherewith to pay the expenses of such 
examination and treatment, the said principal or superintendent 
shall cause such examination and treatment to be made by the 
county physician of the district wherein said child resides; and 
it shall be the duty of such county physician to make such ex- 
amination and treatment, and if he be unable to properly treat 
such child he shall forthwith report such fact to the county 
commissioners of the county with his recommendation. 

Sec. 3. The State Auditor is hereby directed to draw his order 
for such sums and at such times as the State Superintendent 
of Public Instruction may require to carry out the provisions of 
this act. The total expenses under this act shall not exceed 
one thousand ($1,000.00) dollars in any biennial period ending 
November 30. 



Connecticut 

Chapter XXI. — Health, Sanitation, and Safety 

General Statutes, Chapter 131, page 563 
[Enacted 1907] 

Sec. 203. The board of school visitors, board of education, 1907 ch 207 li 

. . Appointment of 

or town school committee of any town, or the board of educa- school 

physicians 

tion or committee of any school district, may appomt one or 
more school physicians and assign one to any public school 
within the limits of such town or school district, and shall pro- 
vide such school physicians, when so appointed, with proper 
facilities for the performance of their duties. 

Sec. 294. Every school physician so appointed shall make 1907 ch 207 I2 
a prompt examination of all children referred to him as here- 
inafter provided, and such further examination of teachers, 
janitors, and school buildings as in his opinion the protection 
of the health of the pupils may require. 

Sec. 295. The superintendent, principal, or teacher of any i,^°.7,^'^ 2°' P 
school to which a school physician has been assigned as herein- referred to phy- 

. sicians for 

before provided shall refer to such physician every child return- examination 
ing to school without a permit from the health officer or board 
of health, after absence on account of illness or from unknown 
cause, and every child attending such school who appears to be 
in ill health, or is suspected to be sick with any contagious 
or infectious disease, unless such child be immediately excluded 



i6 

from such school under the provisions of the general statutes 
or the sanitary regulations in force in said town or district; 
provided, that in the case of schools in remote and isolated loca- 
tions the school committee may make such other arrangements 
as may be advisable to carry out the purposes of this act. 
AMuafe^aL^'* ^EC. 296. The school authorities of any town or school dis- 
chlidren*^ trict which has appointed a school physician in accordance with 

the provisions of this act shall cause every child attending the 
public schools therein to be separately and carefully tested and 
examined at least once in every school year to ascertain whether 
such child is suffering from defective sight or hearing, or from 
any other physical disability tending to prevent such child from 
receiving the full benefit of school work, or requiring a modi- 
fication of such school work in order to prevent injury to the 
child or to secure the best educational results. 
NodceVdL^^ Sec. 297. Notice of the disease or defects, if any, from which 
to^Vrent^or^^" ^^^ child is found by such school physician to be suffering shall be 
guardian given to the parent or guardian of such child with such jadvice 

or order relating thereto as said physician may deem advisable, 
and whenever any child shows symptoms of any contagious 
or infectious disease notice shall also be given to the health 
officer or board of health and such child may be excluded from 
attendance at such school in accordance with the provisions of 
the general statutes or the sanitary regulations in force in 
the town or district. 
Ap°poin'tment!)f ^^^' ^9^' Whenever the board of school visitors, board of 
mfrse"*""^ education, or town school committee of any town, or the board 

of education or district committee of any school district, shall 
have appointed a school physician as provided in Sec. 293, said 
board or committee may also appoint a matron or nurse who 
shall take such action, under the direction of the school physi- 
cian, as may be necessary for safeguarding the health of the 
pupils and teachers of the schools. Such matron or nurse shall 
also act, under the direction of the school physician, as a visit- 
ing nurse in the town or school district, shall visit the homes 
of pupils in the public schools, and shall assist in executing the 
orders of the school physician. 
Ex'iJensMfhoJ' ^^C- 299- The cxpcnses incurred under the provisions of this 
P^'^ act shall be paid in the same manner as are the ordinary expenses 

for the support of schools in the several towns and school dis- 
tricts. 



17 



District of Columbia 

Regulations Governing the Medical Inspection of Public 

Schools 

Promulgated in accordance with an Act making appropriations 
to provide for the expenses of the Government of the District of 
Columbia, approved March 3, 1903. 

Formulated by the Health Officer, June 30, 1903. 

Approved by the Board of Education, June 30, 1903. 

Approved by the Commissioners of the District of Columbia, 
July 14, 1903. 

Amended by the Health Officer, July 7, 1907. 

Approved by the Board of Education, October 9, 1907. 

Approved by the Commissioners of the District of Columbia, 
December 7, 1907. 

Section i. No pupil will be permitted to attend the public when pupils 
schools of the District of Columbia who is suffering from any ^g^d school.^*"' 
defect or disease which renders his presence materially detri- 
mental to the welfare or the safety of other pupils, nor will any 
pupil be permitted to attend school when such attendance will 
materially jeopardize his own health and the condition out of 
which such jeopardy arises is of a temporary character. 

Sec. 2. Every teacher, immediately after the opening of school Teacher shaii 



observe con- 



pu- 



each day, will carefully observe the general expression and con- ditlotT^of 
dition of every pupil and determine whether any of them present ^''^ ^^'^^' 
appearance suggestive of the advisability of exclusion under 
the provisions of these regulations. 

Sec. 3. Every teacher, within one-quarter hour after the open- Teacher shall 
ing of school each day, will forward to the principal of the q°[i^ir''for^' ex- 
building in which she teaches, a written request on the form ^'"'"^''°"- 
provided for that purpose, for the examination by a medical raser^for ex- 
inspector, of each pupil under his care who belongs or appears ^"i'"^*^'""*- 
to belong to any of the following classes : 

Class A. Pupils whose appearances, or known or suggested Exclusion of 
histories, indicate that they may be suffering from conditions gested.^"*^ 
rendering their exclusion from school necessary under the 
provisions of these regulations. 

Class B. Pupils who have returned after having been Pupug return- 
excluded from school on the recommendation of the Health dusion.*^^"^ ^^' 
Officer, or of a medical inspector, except excluded pupils 



i8 



Pupils absent 
for five or 
more consecu- 
tive days. 



Emergency 

examination 

requested. 



Pupils to be 
isolated. 



Suspected 
cases of 
smallpox. 



When pupils 
may remain in 
class room. 



Principal to 
notify in- 
spector. 



Notification 
in case of 
emergency. 



Inspector to 
respond on 
day of 
notice. 



who present certificates signed by the Health Officer authro- 
izing their return; but excluded pupils whose return is 
clearly forbidden by these regulations are not to be referred 
to the medical inspector for examination, but are to be sent 
home at once. 

Class C. Pupils who have been absent from school without 
cause for five or more consecutive school days, unless the 
teacher has reason to believe that the absentee has not 
suff'ered from or been exposed to a communicable disease. 

Requests for the examination of pupils may, however, be 
made out and forwarded to the principal for appropriate 
action, in case of emergency, at any time during the school 
day. 
Sec. 4. Any teacher believing that a pupil in his class is suffer- 
ing from a communicable disease must bring the case to the atten- 
tion of the principal of the building, and the principal must 
isolate the pupil, as well as the facilities at his command will 
permit, pending the arrival of the medical inspector and instruc- 
tion from him as to the disposal of the case; or if the case be 
an urgent one, such for instance as a suspected case of smallpox, 
the principal must submit the facts to the Health Officer at once, 
by telephone or by messenger, and dispose of the case in such 
manner as the Health Officer directs. 

Sec. 5. A teacher may, in her discretion, permit a pupil who 
is not suspected of having a communicable disease to remain 
in the class room pending the arrival of a medical inspector. 

Sec. 6. Every principal of a school will notify the medical 
inspector assigned to such school whenever the services of a 
medical inspector are required. With respect to the examination 
of pupils attending all-day classes or morning classes such noti- 
fication must be given not later than half past nine o'clock, 
and notification with respect to pupils attending afternoon 
classes must be given not later than half past one o'clock. 
If, however, a principal fails to notify the inspector within the 
allowed time, he must notify him as soon thereafter as possible, 
and in case of emergency notification may be given at any time. 
Sec. 7. Every medical inspector, upon receiving notice that 
his services are required at any of the schools to which he has 
been assigned, will respond to such notice on the day of its 
receipt and as soon after its receipt as is practicable. 



19 

Sec. 8. Every medical inspector will devote to actual inspec- inspector to 
tion work each school day not less than three hours. He will than ^three 
first visit each school from which he has received notice to call day'^\o^^inspec- 
and do whatever may be necessary there. If thereafter any 
part of the required three-hour period remains, the inspector order of 
will devote it to the making of routine examinations at schools ^^^^^^ '°"^' 
as hereinafter described. 

Sec. 9. When a medical inspector calls at a school in response inspector to 
to a request for his services he will immediately procure from the ^^^^^^s for ex- 
principal the reports made by teachers in compliance with the principal" ^^°"^ 
requirements of Section 4 of these regulations. Then, with the prindpai to be 
cooperation of the principal, and in his presence or in the presence elamfnatfon. ^' 
of a teacher detailed by the principal for that purpose, he will 
examine all such pupils as are brought to his attention for that 
purpose. In so doing he will afford the principal and teachers obserw^vf- 
every opportunity to observe the evidence and to learn the reason of '^xanfinati^! 
upon which he bases his recommendation, so that the principal and 
teachers may be better able thereafter to select from among the 
pupils under their care those who by reason of defect or disease 
are unfit to attend school. In the making of such examinations 
the principal and teachers will assist the inspector in every pos- Js^s!s?^'^in*°ex- 
sible way. All examinations are to be made with the utmost ammation. 

Examination 

possible privacy and in no case is the examination of an individual to be made 

in private. 

pupil, as distinguished from the examination of an entire class, 
to be made in the class room in the presence of other pupils. 

Sec. id. The medical inspector will indorse on the forms which inspector to 
have been made out by the teacher (Form A) his tentative tive diagnoses 
diagnoses and his recommendations. Notes of the subjective mendations on 
and objective symptoms upon which the inspector bases his '^^'^^^^ " 
recommendations for the exclusion of a pupil from school should 
be made, if the inspector deems it necessary, on the duplicate 
form, but only such notes should be made in this way as can be 
made without disclosing information essentially confidential in 
its nature. 

The "Original" form the inspector will give to the principal Duplicate re- 
of the school for proper action. The "Duplicate" he will se"nt\o°Heaith 
preserve and forward to the Health Ofificer at the close of the o^'^^'^- 
day after having made such a memorandum therefrom as may be 
necessary to enable the inspector to make out his weekly report, original re- 
The principal will forward the "Original" to the supervising se"nt^\o° super- 
principal as soon as practicable, except in cases of exclusion in cipklf ^"°' 



20 



Teachers to 
carry out re- 
commendations. 



Appeals of 
principal from 
decision of 
inspector. 



Routine visits 
of inspector. 



Inspector to 
confer with 
principal. 



Inspector to 
visit classes. 



Inspector to 
call attention 
to sick or de- 
fective pupils. 



which cases the "Original" should be retained by the principal 
until after the pupil has been readmitted or his name erased from 
the school roll. 

Sec. II. The teacher of the school in cooperation with the 
principal will carry out the recommendations of the medical 
inspector as promptly as possible. 

Sec. 12. Should any principal desire to appeal from the decision 
of the inspector, he will first carry out the recommendations of 
such inspector, and after having done so address his appeal, in 
writing, to the supervising principal of the division to which he 
is assigned. The supervising principal may undertake to adjust 
the case by conferring with the Health Officer, either directly or 
through the superintendent of public schools. 

Sec. 13. A medical inspector, in determining which of the 
schools under his supervision shall be visited on any particular 
day independently of requests for his services, will take into 
consideration the length of time that has elapsed since each 
of the various schools under his supervision has been visited, 
whether on special calls or on routine visits, and will endeavor 
to arrange his routine visits so that each of the schools assigned 
to him will receive an equal amount of attention. Routine 
visits may be made during either the morning or the afternoon 
sessions of school, as best suits the convenience of the medical 
inspector, but visits to any one school in which classes are held 
both in the forenoon and in the afternoon should not be con- 
tinuously limited either to the morning or afternoon sessions. 

Sec. 14. A medical inspector, upon visiting a school for the 
purpose of making a routine inspection, will confer with the 
principal and advise him with reference to all such matters of 
hygiene or sanitation as may be brought to the inspector's 
attention. At each such visit the inspector, with the principal 
of the school, or without him, if the principal prefers, will go to 
one or more of the class rooms and to other parts of the building 
and observe the physical condition of the pupils and rooms and 
of the building generally. During such inspections the inspector 
will take occasion to invite the attention of the principal and 
teachers to such apparently sick or defective pupils as he may 
observe and to such conditions in the room and in the building 
generally as require correction, so that appropriate action may 
be taken and similar conditions avoided in the future. 



21 

Inspectors are cautioned that they are not to act as advisers inspectors only 
of principals and teachers, except on matters peculiar to the v'isers tn medi- 
medical profession, and are not to assume the role of critics '=^^™^"^'^®- 
merely. Under no circumstances should advice be given or 
remarks made in the presence of pupils, which can be either 
construed or misconstrued as reflections on the school manage- 
ment. Any apparent dereliction on the part of any janitor 
should be brought privately to the attention of the principal of 
the building in which such janitor is employed, so that appro- 
priate action may be had. 

Sec. IS- Should occasion require the making of a special special inspec- 

• r 11 , -1 • 1 1 r • t'°n of all 

inspection oi all the pupils in any class or classes, as, tor instance, pupUs in a 
for the purpose of determining whether any of them are or are 
not suffering from scarlet fever or pediculosis, the inspector will 
invite the principal to accompany him, and then, either with or 
without the principal, will proceed to the class or classes to be 
examined. There the inspector will look over the pupils in a 
general way, but will make no physical examination of individual 
pupils in the class room. If, in the course of such examination, Order of 

. . M • special inspec- 

it becomes apparent that a closer examination of any pupil is tion. 
desirable, the teacher will, on the request of the inspector, send 
such pupil to some proper place in the building where such ex- 
amination can be made as the inspector deems necessary. For 
each pupil set aside for special examination the teacher will 
make out the usual request for examination as provided by Sec- 
tion 3 of these regulations. 

In connection with the examination of the pupils of any class spedai inspec- 
for the purpose of detecting the presence of pupils suffering from scarlet" fevlr. ° 
scarlet fever, the pupils may be required to raise their hands so 
as to permit the easier and more rapid examination; but in 
such cases the inspector must be careful to avoid touching in 
any way the pupils under examination, at least until after their 
removal to the examination room, and then if it becomes neces- 
sary to touch or handle any pupil, and that pupil is found to 
have scarlet fever the inspector will carefully disinfect his hands 
before proceeding to the examination of other pupils. 

Sec. 1 6. The teacher will give to each pupil whom she excludes giv^'^ pupii° 
from school a proper notice, showing the reason for exclusion SusTon ?n ^' 
and the conditions upon which he will be allowed to return. ^"*''°^' 
And if a pupil, although not formally excluded in the first 
instance, is known to be absent because of conditions which, if exclusion 'is^ to 

be mailed to 
parent. 



22 



Readmission 
after exclusion. 



Differences be- 
tween inspec- 
tors and pa- 
rents, etc., to 
be referred to 
Health Officer. 



Teachers not 
to become 
parties to 
controversy. 



Exclusion for 
grippe, Ger- 
man measles, 
communicable 
diseases of eye, 
parasitic dis- 
ease of hair or 
skin, and other 
conditions not 
affecting health 
of other pupils. 

Return after 
exclusion. 



Pupil to be 
referred to 
inspector for 
examination on 
day of return. 



Return after 
exclusion for 
smallpox, 
scarlet fever, 
diphtheria, 
measles, 
whooping 
cough, 

chickenpox and 
epidemic cere- 
bro-spinal men- 
ingitis. 



he were in attendance, would justify his exclusion, the teacher 
will send a like notice to the parent or guardian of such pupil 
and will give a duplicate thereof to the inspector at the time of 
his next visit. When an excluded pupil has complied with the 
conditions necessary to entitle him to readmission to school the 
teacher will forward the exclusion blank returned by the pupil 
and containing evidence of such compliance through the principal 
to the supervising principal. 

Sec. 17. In event of differences of opinion between a medical 
inspector and the parent, guardian or family physician of any 
pupil relative to the necessity for exclusion of the pupil from 
school, the teacher will refer the parent or guardian to the Health 
Ofhcer, and if the circumstances in his judgment so require, will 
report the facts of the case to the supervising principal. Under 
no circumstances will teachers, principals of schools, medical 
inspectors or supervising principals, allow themselves to become 
parties to a controversy in matters of this kind, but all such 
matters must be settled by conference between the parent or 
guardian and the Health Officer. 

Sec. 18. a pupil who has been excluded from school because of 
conditions not affecting or liable to affect the health of other 
pupils, or because of grippe, German measles, communicable 
disease of the eye, or parasitic disease of the hair or skin, may be 
permitted to return to school at any time after the expiration of 
the period specified in the notice of exclusion. He may be per- 
mitted to return sooner if he presents a certificate from a law- 
fully practicing physician showing that in the judgment of such 
physician he can return with safety to himself and if the pupil 
has suffered from the grippe, German measles, communicable dis- 
ease of the eye, or parasitic disease of the skin or hair, that the 
communicability of the disease has passed. But every such 
pupil must be reported to the medical inspector for examination 
on the day of the pupil's return to school. After having re- 
ported the case the principal and the teacher will be guided in 
their future action by whatever recommendation the medical in- 
spector makes. 

Sec. 19. The return of a pupil to school after he has suffered 
from or been exposed to smallpox, scarlet fever, diphtheria, 
measles, whooping cough, chickenpox and epidemic cerebro- 
spinal meningitis, is regulated primarily by an Act to prevent 
the spread of contagious diseases in the District of Columbia, 



23 



approved March 3, 1897; an Act for the prevention of scarlet 
fever, diphtheria, measles, whooping cough, chickenpox, epi- 
demic cerebro-spinal meningitis and typhoid fever in the District 
of Columbia, approved February 9, 1907, and the regulations for 
the prevention of the diseases just named, promulgated by the 
Commissioners by authority of the latter act, pertinent extracts 
from which laws and regulations appear on pages 60 to 62. In 
order, however, that the health of pupils attending public schools 
may be further safeguarded no pupil who has suffered from 
measles will be permitted to return to school until after the 
expiration of three weeks from the onset of the disease ; no pupil 
suffering from whooping cough until after the expiration of five 
weeks ; no pupil suffering from chickenpox until after the expira- 
tion of two weeks, and no pupil suffering from mumps until after 
the expiration of three weeks. 

A pupil who has suffered from smallpox, scarlet fever, or 
diphtheria may be permitted to return at any time, but only on 
the presentation of a certificate issued by the Health Officer 
authorizing him so to do. No such certificate will be required 
from pupils who have suffered from measles, whooping cough, 
chickenpox, mumps, grippe, German measles, communicable 
disease of the eye and parasitic diseases of the skin and hair, 
but every such pupil must, on the day of his return, be reported 
to the medical inspector for examination. Pupils returning after 
smallpox, scarlet fever and diphtheria, and provided with certifi- 
cates from the Health Officer, need not be so referred, and if not 
provided with such certificate they should be sent home imme- 
diately. Pupils who are not suffering from mumps but have 
merely been exposed to that disease need not be excluded from 
school. 

Sec. 20. If any pupil be excluded from school because of sus- 
pected communicable disease only, the medical inspector will 
visit such pupil on the day following his exclusion for the pur- 
pose of confirming or disproving his tentative diagnosis. If at 
the time of such visit he finds a physician in attendance on the 
case, he will retire without examining the patient, unless he is 
requested by the attending physician to do so. 

Sec. 21. Whenever a pupil is excluded from school on account 
of communicable disease, the medical inspector will recommend 
such disinfection as in his judgment is necessary. Ordinarily 
the seat and desk of the infected pupil must be washed with a 



Period of 
exclusion for 
measles. 
Period of 
exclusion for 
whooping 
cough. 
Period of 
exclusion for 
chickenpox. 
Period of 
exclusion for 
mumps. 



Certificate of 
Health Officer 
required in 
cases of small- 
pox, scarlet 
fever and 
diphtheria. 
When no cer- 
tificate is to be 
required. 



Pupil to be 
referred to 
inspector for 
examination. 
When pupil is 
not to be re- 
ferred to in- 
spector. 

Pupil not to 
be excluded 
for exposure 
to mumps. 



Inspector to 
visit pupil 
after exclusion. 



Inspector to 

recommend 

disinfection. 



24 



Disinfection 
to be done by 
janitors. 
Disinfection 
of books bv 
Health Office. 



Disinfection 
of building. 



Disinfection by 
Health Office. 

Employees to 
assist in dis- 
infection of 
building. 



Detailed list 
of school 
property 
destroyed to 
be furnished. 



Closing of 
a school 
building. 



Superinten- 
dent of schools 
to be notified. 



Superinten- 
dent of schools 
to issue 
instructions. 



Inspectors to 
examine 
teachers or 
janitors. 



proper disinfecting solution; pen-holders, pencils, etc., which 
have been in the possession of the pupil must be treated in the 
same manner if they cannot be destroyed. In some cases it 
will be necessary to wash the handrails of stairways, doorknobs, 
etc. Work of this kind must be done by the janitor of the school 
building. Disinfection of books, when necessary, will be done 
by employees of the Health Department. 

Sec. 22. Whenever in the judgment of the medical inspector, a 
school building or part thereof requires disinfection over and 
beyond that which can be done by the janitor of such building, 
the medical inspector will so notify the Health Officer at the 
earliest possible moment. Whether such disinfection shall or 
shall not be done will be determined by the Health Officer or 
by the inspector in charge of the contagious disease service 
after due consideration of all facts in the case. If such disinfec- 
tion be done, it will be undertaken primarily by employees in 
the service of the Health Department, but all persons connected 
with the school building to be disinfected will render such assis- 
tance as may be practicable. 

Sec. 23. The Health Officer will furnish the superintendent 
of public schools with a detailed statement of all school property 
destroyed because of infection and a certificate showing the 
necessity for such action. 

Sec. 24. If, in the judgment of a medical inspector, any school 
building or part thereof should be closed he will forthwith make 
a recommendation to that effect to the Health Officer, who will 
determine what action should be taken and recommend accord- 
ingly. Recommendations of the Health Officer looking toward 
the closing of any school building or part thereof will be communi- 
cated directly to the office of the superintendent of public schools 
or to his residence, if it be found impracticable to communicate 
with his office. The superintendent of public schools will 
thereupon become responsible for all further action looking 
toward the closing of any such school building or part thereof. 
Teachers and principals will be governed by such instructions 
as they receive from the superintendent of public schools. 

Sec. 25. A medical inspector will, upon the request of the 
principal of a school building, and with the consent of the teacher 
or janitor affected, examine any such principal, teacher or janitor, 
to determine the advisability of such principal, teacher or janitor 
continuing his school duties. Reports and recommendations in 



25 

cases of teachers and janitors will be addressed to the principal 
of the school building, and in the case of principals will be 
addressed to the proper supervising principal. All such reports, 
however, will be delivered by the medical inspector to the princi- 
pal of the school building. 

Sec. 26. This exclusion of teachers and janitors from schools ^ea^hlrs** ami 
and the resumption by them of their school duties will be de- Janitors. 
termined in accordance with these regulations so far as they may 
be applicable. 

Sec. 27. In the event of the occurrence of any emergency f^^l^to'^l^ 
requiring medical aid, the principal of the building will call at 1.™"^^!*^^^^ 
once upon the medical inspector assigned to such building. 
If unable to secure his services with reasonable promptness, he 
will communicate with the Health Department, which will 
arrange for the services of another inspector, or, in some other 
manner supply the needed assistance. 

Sec. 28. Medical inspectors will respond promptly to all calls inspector 
coming from any of the school buildings under their care, or promptly to 

emergency 

from the Health Department, for aid in any case of emergency caiis. 
requiring medical care. 

Sec. 29. Examination of applicants for admission to the normal amination^'at 
school, of pupils in that school seeking graduation, and of appli- g^ard^*^ of^ 
cants for appointment as teachers or janitors, to determine Education. 
their physical fitness for admission, graduation or appointment, 
will be made when requested by the Board of Education by a 
medical inspector or medical inspectors of schools detailed for 
that purpose by the Health Officer. 

Sec. 30. Medical inspectors will note such unsanitary conditions note^'^and *re- 
in and about school buildings as may be called to their attention conditions"*^^^ 
or as may come under their personal observation, and will report 
them to the Health Officer. The Health Officer, if such condi- 
tions arise from property under the control of the Board of 
Education, will report them to that board, and to the Engineer 
Department. Inspectors will bear in mind that they are not 
to act as mere agents for the transmission of complaints of the 
cause of which they have no personal knowledge. 

Sec. 31. Each day, as soon as possible after leaving the last mau^'^dupiicate 
school to be visited, inspectors will mail to the Health Officer the HeSth officer. 
duplicate slips showing tentative diagnoses and recommendations 
which they have made during the day (Form A, Duplicate). 
Before doing so, however, they will note for use in the preparation 



26 



Employees 
held account- 
able for dis- 
closure of 
information. 



Inspectors to 
perform such 
additional 
duties as di- 
rected bv 
Health Officer. 



Inspector to 
report to 
Health Officer 
in case of 
illness. 



Inspectors to 
report to 
Health Officer 
when directed. 



Jurisdiction of 
inspectors. 



Inspectors not 
to treat ex- 
cluded pupils. 



of their weekly report (Form D) such data as may be necessary 
for that purpose. 

Sec. 32. Every officer and agent of the Health Department 
and of the Board of Education will be held strictly accountable 
for any unwarrantable disclosure of information acquired in his 
official capacity. A medical inspector of public schools does not 
lose his character as a physician by reason of his office and 
therefore must not disclose any information which is essentially 
confidential in its character and which he has acquired in his 
official capacity, except to those properly entitled to receive it. 
No such information should ever be embodied in routine reports, 
but if a report is necessary it should be specially and confidentially 
submitted. 

Sec. 33. Medical inspectors will be required to perform such 
duties in connection with the medical inspection of public schools, 
in addition to those specifically described in these regulations, 
as may be directed by the Health Officer. No physical examina- 
tion of the pupils of any entire room or building is to be under- 
taken except so far as may be necessary for the detection of 
communicable diseases and of defects of sight and hearing, 
without the consent of the Board of Education. 

Sec. 34. If by reason of illness or any other cause the medical 
inspector is unable to report at schools under his supervision in 
his usual manner, he will communicate at once with the Health 
Officer, so that proper arrangements can be made for the per- 
formance of his work. A written explanation of such absence 
must in each case be forwarded to the Health Officer as soon as 
practicable. 

Sec. 35. Medical inspectors will report at the Health Office 
from time to time as may be directed by the Health Officer. 
Special meetings of medical inspectors of schools may be called 
at other places in the discretion of the Health Officer. 

Sec. 36. The jurisdiction of the medical inspector of schools 
is limited and defined by these regulations. Visits to pupils 
at their homes or examinations of pupils there may be made only 
as these regulations authorize, and then only with the consent of 
their parents or guardians, and if any such pupil be under the 
care of a physician, the consent of such physician also must be 
obtained. 

Sec. 37. Under no circumstances will a medical inspector 
undertake to treat a pupil, teacher or janitor, who has been 



27 

excluded from school on his recommendation during the period 
of such exclusion, unless such pupil, teacher or janitor, or the 
family of such pupil, teacher or janitor, has been under the pro- 
fessional care of such inspector prior to the occurrence of the 
condition which led to exclusion: provided, however, that any when circulars 
circular or circulars relative to the treatment of pediculosis, ™uTiis. ^ ^'^^" 
ringworm, or any similar condition which the Health Officer 
may furnish may be given to pupils excluded from school because 
suffering from such disease. Any effort to make the office of 
medical inspectors of schools a means for increasing private 
practice will lead to the prompt dismissal of the offender. 

Sec. 38. Every principal of a school will see that there are at fee"to^^edicai 
all times on hand in the building under his supervision a sufficient supplies. 
supply of blanks of all kinds, tongue depressors, disinfectants 
and proper receptacles for the disinfecting solutions, and soap,' 
towels, and a nail brush for the use of the inspector. These 
articles can be obtained by applying to the secretary of the 
Board of Education. 

Medical inspectors will obtain such articles as are needed obtafn'biLks, 
solely for their use in the keeping of their records and the making Heaith'^officer. 
of their reports by application to the Health Officer. Articles 
needed for use in connection with the actual examination of 
pupils and for the making out of recommendations, etc., at school 
buildings, will be supplied in all cases by the principals of such 
buildings. 

Sec. 30. The word "he" and the derivatives thereof wherever derlvaUves. 
used in these regulations are to be read to include the word 
"she" and its corresponding derivatives, respectively, and any 
power and authority conferred upon a principal or teacher in 
and by these regulations may be exercised by any officer in the 
service of the Board of Education, having a higher rank, and 
any power and authority conferred upon a medical inspector 
may be exercised by any officer in the service of the Health De- 
partment with relatively higher standing. 



28 



Indiana 

An Act to Protect and Conserve the Health and Lives of 
School Children and Promote Their Efficiency by 
Providing for Their Medical Inspection and Subse- 
quent Necessary Treatment 

[Enacted 191 1] 

Section i . Be it enacted by the General Assembly of the State 
of Indiana, That all school trustees and township trustees are 
herewith permitted and recommended to institute medical in- 
spection of school children at any time ; the said trustees may re- 
quire teachers to annually test the sight and hearing of all school 
children under their charge, the said tests and uses thereof to be 
made according to the rules hereinafter authorized. 

Sec. 2. The term, medical inspection, as used in this act, shall 
be held to mean — the testing of the sight and hearing of school 
children and the inspection of said children by school physicians 
for diseases, disabilities, decayed teeth or other defects, which 
may reduce efficiency or tend to prevent their receiving the full 
benefits of school work. 

Sec. 3. Beginning with the school year 191 1, school trustees 
and township trustees may appoint at least one school physician 
for each school corporation: Provided, Where practicable, two 
or more school corporations may unite and employ one such 
physician, whose duties shall be such as are prescribed in this act 
and the authorized rules, but not more than 2,000 children shall 
have a school physician. Said school physicians shall be grad- 
uates of a medical college, recognized by the state board of 
registration and examination, shall hold a license to practice 
medicine in Indiana, and shall be informed and skilled in medical 
inspection of children, informed in the health laws and the health 
rules of the state board of health, shall be temperate, able-bodied, 
cleanly in person, not addicted to drugs, and of good moral 
character, and no others shall be appointed. School physicians 
may be discharged by the appointing power at any time for 
written cause. School physicians shall serve one year and until 
their successors are appointed, and shall receive such compensa- 
tion as the appointing trustee or trustees may determine: Pro- 
vided, The compensation shall be not less than $5.00 for each 
school month in the year. 



29 

Sec. 4. School physicians shall make prompt examination and 
diagnosis of all children referred to them and such further ex- 
amination of teachers, janitors and school buildings as in their 
opinion the protection of the health of the pupils and teachers 
may require. Whenever a school child is found to be ill or suffer- 
ing from any physical defect, the school physician shall promptly 
send it home, with a note to parents or guardians, briefly setting 
forth the discovered facts, and advising that the family physician 
be consulted. If the parents or guardians are so poor as to be 
unable to give the relief that is necessary, then school trustees 
and township trustees, as the case may be, shall provide the 
necessary relief: Provided, That in cities where public dispen- 
saries exist, the relief shall be given by said dispensaries. 

School physicians shall keep accurate card-index records of all 
examinations, and said records, that they may be uniform through- 
out the state, shall be according to the form prescribed by the 
rules authorized in this act, and the method and manner of re- 
ports to be made shall be according to said rules. 

Sec. 5. The State board of education and the state board of 
health shall jointly pass rules for the detail enforcement of the 
purposes of this act, which rules shall bear the printed seals of 
said boards ; the said rules to be printed and promulgated by the 
state printing board; promulgation to consist in supplying a 
reasonable number of copies to each county superintendent from 
whom all who are interested may procure a copy. Any violation 
of said rules shall be punished by a fine of not less than five nor 
more than twenty-five dollars. 

Sec. 6. All violations of this act, except as otherwise provided, 
shall be punished by a fine of not less than ten nor more than 
fifty dollars. 

Sec. 7. All acts in conflict with this act are repealed. 



30 



Louisiana 

Sanitary Regulations of the Louisiana State Board of 
Health, Concerning Hygiene and Sanitation of 

Schools 

[Adopted 191 1] 
SANITARY CODE, STATE OF LOUISIANA, SECTION 250— 

(a) The parish or municipal school board, and parish superin- 
tendent of schools, shall be held responsible for the execution and 
enforcement of the following rules and regulations, and all other 
health laws governing the hygiene of the schoolroom and the 
premises of the schools under their respective jurisdictions. 

(b) Plans and specifications for every schoolhouse hereafter 
erected in the State must be submitted to the parish superinten- 
dent of schools, and to the State Superintendent of Education, 
and also to the parish health officer, that it may be determined 
whether every hygienic or necessary provision is made, especially 
with reference to ventilation, light and protection against fire. 

(c) Every schoolhouse, public or private, or other building 
used for school purposes, shall be ventilated in such manner as 
to afford eighteen hundred cubic feet of air per hour for each 
adult, and a proportionate amount for each child, and shall con- 
tain not less than two hundred cubic feet of air space for each 
child to be taught therein. Windows and transoms shall be so 
constructed that windows may be lowered from the top and 
transoms opened. Every schoolhouse must be lighted in such 
a manner as to minimize the eye strain. Each room must con- 
tain of actual surface of glass in the windows not less than one- 
seventh of the floor space. 

(d) All doors except those which slide into wall pockets shall 
open outward, and all partition doors shall be hung on double- 
action hinges. 

(e) The floors of every school must be treated with some 
antiseptic floor dressing. Applications to be at sufficiently 
frequent intervals to keep down effectually the dust; floors to 
be scrubbed thoroughly before each application. Floor dress- 
ings for use in the schools must be approved by the State analyst. 

The floors of every school must be swept daily, sweeping to 
be done after all pupils have left the building. All windows 



31 

must be thrown open and schoolhouse thoroughly aired after 
cleaning. 

All desks, wainscoting, window sills and baseboards in every 
schoolhouse in the State must be wiped off daily with a cloth 
moistened with 1-2000 bichloride of mercury, or 3 per cent, 
carbolic acid solution. 

(f) Spitting on the floors, walls, etc., must be strictly prohib- 
ited and an ti -spitting placards placed in every room. 

(g) No person suffering from any communicable disease shall 
be employed as teacher or janitor in any public school in this 
State. At the opening of each annual term teachers must furnish 
a health certificate from a registered physician, addressed to the 
parish superintendent of schools, certifying that they are not 
suffering from tuberculosis or other communicable disease. 

No one shall be entered as a pupil in the public schools of 
this State without first having presented to the principal in 
charge a certificate from a registered physician of Louisiana, 
certifying that within the preceding five years the applicant 
was successfully vaccinated. 

Three unsuccessful attempts at vaccination with a proven 
virus shall be accepted as an immunity for a period of one year. 

Pupils are required, at the end of each five years, to renew 
their vaccination certificates. 

(h) No pupil suffering from any communicable disease shall 
be permitted to attend the public schools of this State. The 
principal or the teacher has the right to exclude any child from 
the schools whom they suspect of suffering from any communi- 
cable disease, pending examination and report of a registered 
physician. 

(i) All schoolrooms in the State must be disinfected before 
the beginning of each school session, with the formaldehyde- 
permanganate of potash mixture as indicated in the bulletin of 
disinfection. 

(j) On the appearance in a school of any communicable disease, 
either among the pupils, teachers or attendants, the school 
shall be closed immediately and fumigated before re-opening. 

(k) The school premises shall be thoroughly drained and 
no stagnant water permitted to collect. In towns with a drain- 
age system, or where an outflow is possible, the school site and 
the entire area of the ground shall be properly drained, so as to 
reduce the ground water level, and the drainage effected in such 



32 

manner as not to contaminate with its effluvia any well, cistern 
or other source of drinking water. 

(I) Every school must be supplied with an abundance of 
pure drinking water for drinking purposes. Where water is 
used from surface wells, said wells must be located at least lOO 
feet from any closet. 

(m) The use of open receptacles for drinking water in schools, 
and also of dippers or cups for common drinking purposes, is 
prohibited. The school authorities must supply for holding 
drinking water covered containers with faucets, which con- 
tainers must be scoured daily when in use. All teachers and 
pupils must provide themselves with individual drinking cups 
or glasses. In towns or cities where there is a public water 
supply a sanitary drinking fountain shall be installed. 

(n) Every school in this State must have a sufficient number 
of trash or garbage cans for the convenience of the pupils, 
teachers and employees, and said trash or garbage cans must 
be kept closed, and emptied daily. 

(o) The urinals and water closets must be connected with 
the sewerage system, where one exists, when within looo feet 
therefrom. Where no sewerage system exists, all schools 
must have a Stiles sanitary closet (plans and specifications will 
be furnished by the State Board of Health upon request), cess- 
pool or septic tank. Where the Stiles sanitary closet is used 
the inner surface of the container must be treated with crude 
petroleum at least once a week. All closets must be scrubbed 
once a week and kept in a sanitary condition at all times. 

(p) The State Board of Health will, when desired by the 
State institutions of learning, or the State Pedagogical Insti- 
tutes, or the Agricultural Institutes, send a lecturer to deliver 
a series of lectures on: 

1. Personal hygiene. 

2. School hygiene. 

3. Principles and practice of physical training. 

4. Drug and alcohol addictions. 

5. Contagious and infectious diseases; cause and prevention. 

6. Hygiene of the home and farm. 

(q) The principal of each school in the State, except in cities 
where there is employed a regular medical inspector, shall make 
a monthly report to the parish superintendent of schools on the 
sanitary condition of the school building and surroundings, also 



33 

the physical condition of the school children. Blank reports 
for this purpose will be furnished by the Louisiana State Board 
of Health. Parish superintendents of schools shall forward 
these reports to the Louisiana State Board of Health within ten 
days after their receipt by him. 



Maine 

An Act Relative to the Appointment of School Physicians 

(Chap. 73, P. L. 1909) 
[Approved March 16, 1909] 

Section i . The school committee of every city and town shall school 
appoint one or more school physicians and shall assign one to pointment' of . 
the medical inspection of not over one thousand pupils of the 
public schools within its city or town, and shall provide them 
with all proper facilities for the performance of their duties 
as prescribed in this act, provided, however, the said committee 
has been so authorized by vote of town at regular town meeting 
or at a special town meeting called for that purpose. 

Sec. 2. Every school physician shall make a prompt exami- Duties of 

, . physician. 

nation and diagnosis of all children referred to him as herein- 
after provided, and such further examination of teachers, jani- 
tors and school buildings as in his opinion the protection of the 
health of the pupils may require. 

Sec. 3. The pupils so examined by school physicians when PupUs, by 

, ., , f , , 111 whom treated. 

treatment is necessary shall not be referred to the school phy- 
sicians for such treatment except the school physician be the 
regular family physician of such pupil, but shall be referred to 
the regular family physician of such pupil through the parents 
or guardian. 

Sec. 4. The school committee shall cause to be referred to Examination of 
a school physician for examination and diagnosis every child absence on 
returning to a school without a certificate from the board of sickness. 
health or family physician after absence on account of illness or 
from unknown cause; and every child in the schools under its 
jurisdiction who shows signs of being in ill health or of suffer- 
ing from infectious or contagious diseases, unless he is at once 
excluded from school by the teacher; except that in case of —exception 
3 



34 



Notice 
disease 
defects. 



Examination of 
siglit and 
hearing. 



— notice to 
parent or 
guardian. 



State super- 
intendent of 
schools shall 
prescribe direc- 
tions for tests 
of sight and 
hearing. 

— amount to be 
expended. 



Expense that 
may be in- 
curred by city 
or town. 



schools in remote and isolated situations, the school committee 
may make such other arrangements as may best carry out the 
purposes of this act. 

Sec. 5. The school committee shall cause notice of disease 
or defects, if any, from which any child is found to be suffer- 
ing to be sent home to his parents or guardian. Whenever a 
child shows symptoms of smallpox, scarlet fever, measles, 
chicken pox, tuberculosis, diphtheria or influenza, tonsilitis, 
whooping cough, mumps, scabies or trachoma, he shall be sent 
home immediately or as soon as safe and proper conveyance can 
be found, and the board of health and superintendent of schools 
shall at once be notified. 

Sec. 6. The school committee of every city or town shall 
cause every child in the public schools to be separately and care- 
fully tested and examined at least once in every school year to 
ascertain whether he is suffering from defective sight or hear- 
ing or from any other disability or defect tending to prevent 
his receiving the full benefit of his school work, or requiring a 
modification of the school work in order to prevent injury to 
the child or to secure the best educational results. Tests of 
sight and hearing shall be made by the teachers or by the school 
physicians. The committee shall cause notice of any defect or 
disability requiring treatment to be sent to the parent or guar- 
dian of the child, and shall require a physical record of each 
child to be kept in such form as the state superintendent of 
public schools shall prescribe after consultation with the state 
board of health. 

Sec. 7. The state superintendent of public schools shall pre- 
scribe after consultation with the state board of health the 
directions for tests of sight and hearing, and shall prescribe and 
furnish to the school committees suitable rules of instruction, 
test cards, blanks, record books and other useful appliances for 
carrying out the purposes of this act. The state superintendent 
of public schools may expend during the year nineteen hundred 
and nine a sum not greater than five hundred dollars for the 
purpose of supplying the material required for this act. 

Sec. 8. Expenses which a city or town may incur by virtue 
of the authority herein vested in the school committee shall not 
exceed the amount appropriated for that purpose in cities by 
the city council and in towns by a town meeting. The appro- 
priation shall precede any expenditure of any indebtedness 



35 

which may be incurred under this act and the sum appropriated 
shall be deemed sufficient appropriation in the municipality 
where it is made. Such appropriation need not specify to what 
section of the act it shall apply and may be voted as a total 
appropriation to be applied in carrying out the purposes of this 
act. 

Sec. 9. The provision of this act shall apply only to cities ^ties'^^nd 
and towns having a population of less than forty thousand [esl^than^^orty 
inhabitants. hawtants. ""' 



Massachusetts 

(Chapter 502, Acts of 1906) 

APPOINTMENT OF SCHOOL PHYSICIANS, ETC. 
Section i. (As amended by chapter 257, Acts of igio.) The 
school committee of every city and town in the Commonwealth 
shall appoint one or more school physicians, shall assign one to 
each public school within its city or town, and shall provide 
them with all proper facilities for the performance of their duties 
as prescribed in this act; and shall assign one or more to perform 
the duty of examining children who apply for health certificates in 
accordance with this act: provided, however, that in cities wherein 
the board of health is already maintaining or shall hereafter 
maintain substantially such medical inspection as this act 
requires, the board of health shall appoint and assign the school 
physician. 

EXAMINATION AND DIAGNOSIS TO BE MADE 
Sec. 2. {As amended hy chapter 2^y, Acts of igio.) Every 
school physician shall make a prompt examination and diagnosis 
of all children referred to him as hereinafter provided, and such 
further examination of teachers, janitors and school buildings as 
in his opinion the protection of the health of the pupils may re- 
quire. Every school physician who is assigned to perform the 
duty of examining children who apply for health certificates shall 
make a prompt examination of every child who wishes to obtain 
an age and schooling certificate, as provided in section sixty of 
chapter five hundred and fourteen of the acts of the year nineteen 
hundred and nine, and who presents to said physician an employ- 



36 

ment ticket, as provided in said section, and the physician shall 
certify in writing whether or not in his opinion such child is in 
sufficiently sound health and physically able to perform the work 
which the child intends to do. 

AUTHORITY OF SCHOOL COMMITTEES, ETC. 
Sec. 3. The school committee shall cause to be referred to a 
school physician for examination and diagnosis every child 
returning to school without a certificate from the board of health 
after absence on account of illness or from unknown cause; and 
every child in the schools under its jurisdiction who shows signs 
of being in ill health or of suffering from infectious or contagious 
disease, unless he is at once excluded from school by the teacher; 
except that in the case of schools in remote and isolated situations 
the school committee may make such other arrangements as 
may best carry out the purposes of this act. 

NOTICE TO BE SENT TO PARENT OR GUARDIAN 
Sec. 4. The school committee shall cause notice of the disease 
or defects, if any, from which any child is found to be suffering 
to be sent to his parents or guardian. Whenever a child shows 
symptoms of smallpox, scarlet fever, measles, chickenpox, 
tuberculosis, diphtheria or influenza, tonsilitis, whooping cough, 
mumps, scabies or trachoma, he shall be sent home immediately, 
or as soon as safe and proper conveyance can be found, and the 
board of health shall at once be notified. 

TESTS OF SIGHT AND HEARING, AND EXAMINATION FOR DIS- 
ABILITY OR DEFECTS 

Sec. 5. The school committee of every city and town shall 
cause every child in the public schools to be separately and care- 
fully tested and examined at least once in every school year to 
ascertain whether he is suffering from defective sight or hearing 
or from any other disability or defect tending to prevent his 
receiving the full benefit of his school work, or requiring a modi- 
fication of the school work in order to prevent injury to the child 
or to secure the best educational results. The tests of sight and 
hearing shall be made by teachers. The committee shall cause 
notice of any defect or disability requiring treatment to be sent 
to the parents or guardian of the child, and shall require a physical 
record of each child to be kept in such form as the state board of 
education shall prescribe. 



37 

STATE BOARD OF HEx\LTH TO PRESCRIBE DIRECTIONS; STATE 
BOARD OF EDUCATION TO FURNISH RULES, ETC. 

Sec. 6. The state board of health shall prescribe the directions 
for tests of sight and hearing and the state board of education 
shall, after consultation with the state board of health, prescribe 
and furnish to school committees suitable rules of instruction, 
test-cards, blanks, record books and other useful appliances for 
carrying out the purposes of this act, and shall provide for 
pupils in the normal schools instruction and practice in the best 
methods of testing the sight and hearing of children. The state 
board of education may expend during the year nineteen hundred 
and six a sum not greater than fifteen hundred dollars, and annu- 
ally thereafter a sum not greater than five hundred dollars* 
for the purpose of supplying the material required by this act. 

CHAPTER 257, ACTS OF 1910 

Sections i and 2 of chapter 257 amend sections i and 2 of 
chapter 502, Acts of 1906, as given above. 

Section 3 of chapter 257 amends section 58 of chapter 514, 
Acts of 1909, as given below. 

An age and schooling certificate shall be approved only by the 
superintendent of schools or by a person authorized by him in 
writing, or, if there is no superintendent of schools, by a person 
authorized by the school committee ; but no member of a school 
committee or other person authorized as aforesaid shall approve 
such certificate for any minor then in or about to enter his own 
employment or the employment of a firm or corporation of which 
he is a member, officer or employee. No such certificate shall 
be approved by any person unless he is satisfied that the minor 
therein named is able to read at sight and to write legibly simple 
sentences in the English language, nor until such person has 
received a certificate signed by a physician, as provided in chapter 
five hundred and two of the acts of the year nineteen hundred and 
six and acts passed in amendment thereof, or by a physician ap- 
pointed by the school committee, stating that said minor has been 
exanmied by him and in his opinion is in sufficiently sound health 
and physically able to perform the work which the minor intends 
to do; provided, however, that the age and schooling certificate may 
be approved and issued without a physician s certificate if there 
shall be on file in connection with the public schools a written record 
* Eight hundred dollars now appropriated under chapter 189, Acts of 1908. 



38 

in regard to the child's physical condition made within one year and 
the person authorized to approve said age and schooling certificate 
after having examined such record shall certify that in his opinion 
said minor is in sufficiently sound health and physically able to 
perform the work which the minor intends to do. The person 
who approves the certificate may administer the oath provided 
for therein, but no fee shall be charged therefor. 

Section 4 of chapter 257, Acts of 1910, amends, as given 
below, section 60, Acts of 1909. 

EMPLOYMENT TICKET AND AGE AND SCHOOLING CERTIFICATE 
The age and schooling certificate of a minor under sixteen 
years of age shall not be approved and signed until he presents to 
the person who is authorized to approve and sign it an employ- 
ment ticket duly filled out and signed. A duplicate of each age 
and schooling certificate shall be filled out and shall be kept on 
file by the school committee. Any explanatory matter may, in 
the discretion of the school committee or superintendent of 
schools, be printed with such certificate. The employment 
ticket and the age and schooling certificate shall be separately 
printed and shall be filled out, signed and held or surrendered 
as indicated in the following forms: — 

EMPLOYMENT TICKET, ST. 1909, C. 514, ?6o 
When [name of minor] , height [feet and inches] 

, complexion [fair or dark] , hair [color] 

presents an age and schooling certificate duly signed, I intend to 
employ [him or her]. 

(Signature of intending employer or agent.) (Town or city 
and date.) 

AGE AND SCHOOLING CERTIFICATE, ST. 1909, C. 514, §60, AS 
AMENDED BY ST. 1910, C. 257, §4 

This certifies that I am the [father, mother, guardian or 
custodian] of [name of minor], and that [he or she] was born 
at [name of city or town], in the county of [name of county, if 
known], and state [or country] of , on the [day and year 

of birth], and is now [number of years and months] old. 

[Signature of father, mother, guardian or custodian.] 

[City or town and date.] 

Then personally appeared before me the above-named [name 



39 

of person signing], and made oath that the foregoing certificate 
by [him or her] signed is true to the best of [his or her] knowledge 
and beUef, I hereby approve the foregoing certificate of [name 
of minor], height [feet and inches], complexion [fair or dark], 
hair [color], having no sufficient reason to doubt that [he or she] 
is of the age herein certified. I hereby certify and am satisfied 
that [he or she] can read at sight and can write legibly simple 
sentences in the English language. I further certify that in 
my opinion [or in the opinion of , the physician 

by whom said minor has been examined in accordance with 
section fifty-eight of the above chapter] he [or she] is in sufficiently 
sound health and physically able to perform the work which he 
[or she] intends to do. 

This certificate belongs to [name of minor in whose behalf it 
is drawn], and is to be surrendered to [him or her] whenever 
[he or she] leaves the service of the corporation or employer 
holding the. same ; but if not claimed by said minor within thirty 
days after such time, it shall be returned to the superintendent 
of schools, or, if there is no superintendent of schools, to the school 
committee. 

[Signature of person authorized to approve and sign, 
with official character or authority.] 

[City or town and date.] 

In the case of a minor who cannot read at sight and write 
legibly simple sentences in the English language, the certificate 
shall continue as follows, after the word "language": — 

I hereby certify that [he or she] is regularly attending the 
[name] public evening school. This certificate 

shall continue in force only so long as the regular attendance 
of said minor at the evening school is endorsed weekly by a 
teacher thereof. 

This act shall take effect on the first day of August in the year 
nineteen hundred and ten. 



40 



Minnesota 

Regulations of the Minnesota State Board of Health 

[Adopted June 15, 1910] 
PROTECTING THE HEALTH OF SCHOOL CHILDREN 

71. The local board of health of every city, village and town- 
ship in Minnesota shall appoint one or more school physicians, 
shall assign a school physician to every school within the city, 
village or township, shall provide him with all necessary blanks 
and proper facilities for the performance of his duties and shall 
require him to call at such intervals as may be prescribed by the 
local board of health, or whenever notified so to do by the head 
of the school, at the school building or buildings under his juris- 
diction ; except that, in the case of schools in remote and isolated 
situations, the local board of health may, after consultation with 
the State Board of Health, make such other arrangement as 
may best carry out the purpose of this regulation. 

72. Each school physician shall make a medical examination 
of all school children referred to him for that purpose, and such 
examination of pupils, teachers and janitors, and of school 
buildings as in his opinion the protection of the health of the 
public may require, and shall report the results of such examina- 
tions to the State Board of Health. 

73. The local board of health of every city and village shall 
require every teacher to report each morning to the head of the 
school the case of every child belonging to his or her room who 
shows signs of being in ill health or suffering from a communicable 
disease; also every child returning to school after absence on 
account of illness of unknown cause. The head of the school, 
upon receiving such report, shall as soon as possible thereafter 
notify the school physician and refer to him all such cases for 
examination. Whenever, in the opinion of the head of the school, 
a child's condition requires that he or she be sent home, and 
whenever a child shows symptoms of smallpox, scarlet fever, 
diphtheria, measles, chicken pox, tuberculosis, influenza, tonsili- 
tis, erysipelas, whooping cough, mumps, itch, ringworm or 
trachoma, he or she shall send such suspect home immediately, 
or as soon as a safe and proper conveyance can be found, and the 
local health officer shall be notified at once by the head of the 
school of such case. 



41 

74- In the event of any school child having smallpox, or having 
been exposed to the disease while in attendance at school, the 
building where such child is in attendance shall be closed by the 
order of the local health officer and kept closed until the place 
has been thoroughly disinfected and cleansed under the super- 
vision of said health officer. 

In the event of- the Board of Education having passed a regula- 
tion requiring vaccination of all teachers and pupils, the school 
may be opened after the above disinfection and cleansing; 
otherwise the school shall be kept closed until the local board of 
health, with the approval of the State Board of Health, directs 
otherwise. 

75. No principal, superintendent or teacher of any school, and 
no parent, master or guardian of any child or minor, having the 
power and authority to prevent, shall permit any such child or 
minor having small-pox, scarlet fever, diphtheria, measles, chicken- 
pox, tuberculosis, influenza, tonsilitis, erysipelas, whooping cough, 
mumps, itch, ringworm or trachoma, or any other dangerous 
communicable disease, or any child residing in any house in which 
any such disease exists or has recently existed, to attend any 
public, private, parochial, church or Sunday school until the 
local health officer of the city, village or township shall have 
given his permission for such attendance. 

76. A school house wherein a child suffering from scarlet fever 
or diphtheria has been present shall be deemed infected and must 
be temporarily closed and thoroughly disinfected and cleaned 
under the supervision of the local health officer before the re- 
opening of the school. Such disinfection and cleaning shall be 
done according to the direction of the Minnesota State Board of 
Health in its circular on disinfection. 

77. All school houses shall be inspected from time to time by 
the local health officer, and if found to be in an unclean or 
unsanitary condition, said health officer shall forthwith order 
that the place be closed and kept closed until it has been properly 
cleaned or disinfected, or both, as the case may require. 

78. The local board of health of every city and village shall 
cause every child in the public schools to be separately and 
carefully tested and examined at least once in every school year 
in order to ascertain whether he or she is suffering from defective 
sight or hearing, or from any other disability tending to prevent 
his or her receiving the full benefit of the school work, or requiring 



42 

a modification of the school work in order to prevent injury to 
the child or to secure the best educational results for such child. 
Tests of sight and hearing shall be made by teachers and reported 
to the Minnesota State Board of Health by the head of the school. 
The head of the school shall cause notice of any defect or disa- 
bility in any child requiring treatment to be sent to the parent 
or guardian of the child. 

79. The Minnesota State Board of Health shall prescribe 
and furnish to the superintendents of schools suitable rules of 
instructions, test cards, blanks, records and other appliances for 
carrying out the above regulations. The several Normal 
Boards of the state shall provide for pupils in the Normal Schools 
the instruction and practice prescribed by the State Board of 
Health for testing the sight and hearing of school children. 



New Jersey 

Chapter 92, P. L. 1909 — Relating to Medical Inspection 

[Approved April 13, 1909] 

229. Every board of education shall employ a competent 
physician to be known as the medical inspector and fix his salary 
and term of office. Every board of education shall adopt rules 
for the government of the medical inspector, which rules shall 
be submitted to the State Board of Education for approval. 

The medical inspector shall examine every pupil to learn 
whether any physical defect exists, and keep a record from year 
to year of the growth and development of such pupil, which 
record shall be the property of the board of education, and 
shall be delivered by said medical inspector to his successor in 
office. Said inspector shall lecture before the teachers at such 
times as may be designated by the board of education, instructing 
them concerning the methods employed to detect the first signs 
of communicable disease and the recognized measures for the 
promotion of health and the prevention of disease. The board 
of education may appoint more than one medical inspector. A 
board of education may exclude from school any child whose 
presence in the school-room shall be certified by the medical 
inspector as detrimental to the health or cleanliness of the pupils 



43 

in the school, and shall notify the parent, guardian or other 
person having control of such child of the reason therefor. If 
the cause for exclusion is such that it can be remedied, and the 
parent, guardian or other person having control of the child 
excluded as aforesaid shall fail or neglect within a reasonable 
time to have the cause for such exclusion removed, such parent, 
guardian or other person shall be proceeded against, and, upon 
conviction, be punishable as a disorderly person. 
This act shall take effect immediately. 



New York 

Chapter 602. — An Act to Amend the Education Law, in 
Relation to the Powers and Duties of Boards of 

Education 

Became a law June 23, 1910 

The People of the State of New York, represented in Senate and 
Assembly, do enact as follows: 

Section i. Section three hundred and ten of chapter twenty- 
one of the laws of nineteen hundred and nine, entitled "An act 
relating to education, constituting chapter sixteen of the consoli- 
dated laws," as amended by chapter one hundred and forty of 
the laws of nineteen hundred and ten, is hereby amended by adding 
thereto a new subdivision, to be known as subdivision twenty- 
one, and to read as follows: 

21. To provide for the medical inspection of all children in 
attendance upon schools under their supervision whenever in 
their judgment such inspection shall be necessary and to pay 
any expense incurred therefor out of funds authorized by the 
voters of the district or city or which may properly be set aside 
for such purpose by the common council or the board of esti- 
mate and apportionment of a city. 

Sec. 2. This act shall take effect immediately. 



44 

North Dakota 

[Enacted 191 1] 

Section 238. Medical Inspection of Schools. The board 
of any school corporation may employ one or more physicians 
as medical inspector of schools. It shall be the duty of the 
medical inspector to examine, at least once annually, all children 
enrolled in the public schools of the district, except those who 
present a certificate of health from a licensed physician, and to 
make out suitable records for each child, one copy of which shall 
be filed with the county or city superintendent of schools. Notice 
of physical defects of abnormal or diseased children shall be sent 
to the parents, with recommendations for the parent's guidance 
in conserving the child's health. The medical inspector shall 
co-operate with state, county and township boards of health in 
dealing with contagious and infectious diseases and to secure 
medical treatment for indigent children. It shall be the duty 
of the county and city superintendents of schools to co-operate 
with school boards in promoting medical inspection. He may 
arrange schools by groups, especially in the rural districts, for 
purposes of inspection, and shall advise school boards with a view 
to securing the most efificient and economical administrations of 
this law. The school board or board of education shall furnish 
all blanks and other needed supplies for this purpose. 



Ohio 

[Enacted 19 lo] 

Medical SECTION 7692. Any board of education in a city school district 

may provide for the medical inspection of pupils attending the 
public schools. For that purpose it can employ competent 
physicians, nurses, and provide for and pay all expenses incident 
thereto from the public school funds, or by agreement with the 
board of health or other board or officer performing the functions 
of a board of health for such city. It may provide for medical 
and sanitary supervision and inspection of the schools which are 
under the control of such board of education and of the pupils 



45 

attending such schools, by a competent physician selected by 
the parent or guardian of the child, but on failure of the parent 
or guardian, then by the district physicians and other employes 
to be appointed by such board of health. (R. S. Sec. 4018a.) 

Sec. 7693. A board of education in a city school district mak- Compensation 
ing such agreement may provide and pay compensation to the 
employes of the board of health in addition to that provided by 
the city. (R. S. Sec. 4018a.) 



Pennsylvania 

School Code 
Article XV 



MEDICAL INSPECTION AND HYGIENE 
[Enacted 191 1] 

Section 1501. Every school district of the first second or 
third class in this Commonwealth shall annually provide medical 
inspection of all the pupils of its public schools by proper medical 
inspectors to be appointed by the board of school directors of the 
district. Such medical inspection shall be made in the presence 
of the parent or guardian of the pupil when so requested by 
parent or guardian. All such medical inspectors shall be phy- 
sicians legally qualified to practice medicine in this Common- 
wealth who have had at least two years' experience in the prac- 
tice of their profession and shall be paid such amounts as the 
boards of school directors may determine. Provided that noth- 
ing in this act shall preclude the appointment of health officers 
of municipalities as medical inspectors in the school districts of 
this Commonwealth. Provided further that if in any year before 
the first day of August the hoard of school directors of any school dis- 
trict of the third class shall decide by a majority vote of the members 
thereof not to have medical inspection in any or all of the schools 
of such district such medical inspection shall not be made in such 
schools during the following school year. 

Sec. 1502. In school districts of the first class wherein the 
Department or Board of Health therein is providing the medical 



46 

inspection for the public schools as required by this act said De- 
partment or Board of Health may if it so elects continue to pro- 
vide such medical inspection and appoint such number of in- 
spectors therefor with such salaries as shall he satisfactory to the 
hoard of school directors of the district and the medical inspection 
so provided shall be deemed a compliance with this act and shall 
be paid for by the school district. 

Sec. 1503. In every school district of the fourth class in this 
Commonwealth the State Department of Health shall provide 
in such manner as it may determine medical inspection for all 
the pupils in the public schools by proper medical inspectors 
to be appointed by the State Commissioner of Health at the 
expense of said Department. All such medical inspectors shall 
be legally qualified physicians who have had not less than two 
years' experience in the practice of their profession. Such 
medical inspection shall be made in the presence of the parent or 
guardian of the pupil when so requested by parent or guardian. 
Provided that if the hoard of school directors of any school district 
of the fourth class shall decide by a majority vote of the members 
thereof not to have medical inspection of the pupils in a part or all 
of the schools of such district and the Commissioner of Health is 
officially notified thereof in writing before the first day of July such 
medical inspection shall not be made in such schools during the 
following school year. 

Sec. 1504. If in any school district which is required by this 
act to provide medical inspection for its public schools such medical 
inspection as is herein required is not furnished within thirty days 
after the beginning of the school year the Commissioner of Health 
shall after two weeks' written notice to the board of school 
directors of such district appoint a properly qualified medical 
inspector or inspectors for the district for the remainder of the 
school year and shall fix the compensation for the same which 
shall be paid by the district. 

Sec. 1505. The medical inspectors shall at least once each year 
inspect and carefully test and examine all pupils in the public 
schools of their districts giving special attention to defective 
sight hearing or other disabilities and defects specified by the 
Commissioner of Health in his directions for the medical ex- 
aminations of schools. Each medical inspector shall make to the 
teacher or if the board of school directors so directs to the prin- 
cipal or district superintendent of schools a written report con- 



47 

cerning all pupils found to need medical or surgical attention 
and giving careful directions concerning the care of each pupil 
who needs special care while in school. The teacher or the prin- 
cipal or district superintendent shall keep such report until the 
end of the school year shall carry out as carefully as possible said 
directions concerning the special care of pupils while in school 
and shall promptly send a copy of the medical inspector's report 
upon each child to the parents or guardian thereof. 

Sec. 1506. The medical inspector shall at least once each year 
and as early in the school term as possible make a careful examina- 
tion of all privies water closets urinals cellars the water supply 
and drinking vessels and utensils and shall make such additional 
examinations of the sanitary conditions of the school buildings 
and grounds as he deems necessary or as the regulations of the 
State Department of Health or the rules of the board of school 
directors or of the local board of health require. He shall see 
that the laws of the Commonwealth relating to the health and 
sanitation of the public schools and the requirements of the local 
board of health are complied with. 

Sec. 1507. He shall promptly make such reports to the Com- 
missioner of Health as are required by him or by the regulations 
of his department and such reports to the local boards of school 
directors as he deems necessary or as are required by the Com- 
missioner of Health or by the board of school directors. He 
shall perform such other duties as may be required by the health 
and sanitation laws of this Commonwealth or by the board of 
school directors. 

Sec. 1508. Any board of school directors may employ one or 
more school nurses who shall be graduates of reputable training 
schools for nurses and shall define their duties. 

Sec. 1509. No person having tuberculosis of the lungs shall be 
a pupil teacher janitor or other employee in any public school 
unless it be a special school carried on under the regulations 
made for such schools by the Commissioner of Health. 

Sec. 1510. Any pupil prevented from attending school on 
account of the health or sanitation laws of this Commonwealth 
or by the sanitary regulations of the local board of health or the 
board of school directors is hereby relieved from complying with 
the provisions of this Act concerning compulsory attendance 
during such time as he is thereby prevented from attending school. 



48 



Utah 

Chapter 140. — An Act Requiring the Examination of All 

School Children to Ascertain if They have Defective 

Sight or Hearing, or Diseased Teeth, or if They 

are Addicted to Mouth Breathing 

[Approved March 20, 191 1] 

Be it enacted by the Legislature of the State of Utah: 

Section i. It shall be the duty of every teacher engaged in 
teaching in the public schools of the State, separately and care- 
fully, to test and examine every child under his jurisdiction to 
ascertain if such child is suffering from defective sight or hearing, 
or diseased teeth, or breathes through its mouth. If such test 
determines that any child has such defect it shall be the duty 
of the teacher to notify, in writing, the parent of the child of 
such defect and explain to such parent the necessity of medical 
attendance for such child. 

Sec. 2. The State Board of Health shall prescribe rules for 
making such tests, and shall furnish to Boards of Education 
and Boards of Trustees of school districts, rules of instruction, 
test cards, blanks and other useful appliances for carrying out 
the purposes of this Act. 

Sec. 3. During the first month of each school year, after the 
opening of school, teachers must make the tests required by 
this Act upon the children then in attendance at school; and 
thereafter, as children enter school during the year, such tests 
must be made immediately upon their entrance. 

Sec. 4. It shall be the duty of the Boards of Education and 
Boards of Trustees of the several school districts of the State to 
enforce the provisions of this Act. 

Sec. 5. The Board of Education or Board of Trustees of any 
school district may employ regularly licensed physicians to make 
the tests required by Section i of this Act, and when such tests 
are made by a physician, the teachers shall not be required to 
make the tests provided for in Section i of this Act. 



49 

Vermont 

[Approved November ii, 1910] 

Number 73. — An Act to Provide for the Medical Inspec- 
tion OF Public and Private Schools 

// is hereby enacted by the General Assembly of the State of Vermont: 

Section i. The school directors of any town or city, or the 
school committee of any incorporated district, may appoint one 
or more medical inspectors for their schools, provided the legal 
voters of such town, city, or incorporated district at their annual 
school meeting by vote instruct said directors or committee so 
to do. The compensation of such inspectors shall be fixed by 
the school directors or prudential committee. 

Sec. 2. Such medical inspectors shall examine the pupils of 
said schools, and in all things comply with such rules and regula- 
tions as may be promulgated by the state board of health relating 
thereto. 

Sec. 3. Said inspectors shall, under the same regulations, 
examine the pupils of any private school when requested so to 
do by the principal thereof, or whenever any communicable 
disease is present in any town or city in which such private 
school may be located, or when the pupils thereof may have been 
exposed to any communicable disease. 

Sec. 4. This act shall take effect September i, 1911. 



Virginia 

[Enacted 191 o] 

"The school boards of the cities and counties may, in their 
discretion, select and appoint medical inspectors of school 
children whose duties and compensation shall be prescribed by 
the respective boards, and who shall report to and be under the 
control of said boards." 



50 



Washington 



Code of Public Instruction. Chapter 97, Session Laws of 
1909. — Paragraph 191, Applying to Districts of the 
First Class 

Fourteenth. To appoint a practising physician, resident of 
the school district, who shall be known as the School District 
Medical Inspector, and whose duty it shall be to decide for the 
board of directors all questions of sanitation and health affecting 
the safety and welfare of the public schools of the district; he 
or authorized deputies shall make monthly inspections of each 
school in the district and report the condition of the same to the 
Board of Education and Board of Health. 



West Virginia 

[Enacted February, 191 1] 

An Act to JEstablish Medical Inspection in Public Schools 
Be it enacted by the Legislature of West Virginia: 

That the board of education of each independent school district 
in this state shall and other boards of education may within 
ninety days from the passage hereof and thereafter on the first 
day of January of each year, appoint one or more legally qualified 
practising physicians in said school district to be known as medical 
inspector of schools, fix their salaries and define their duties as 
hereinafter provided, and furnish the necessary stationery and 
printing for records and reports. 

It shall be the duty of the medical inspector of schools to 
separately and carefully test each pupil in his school once during 
each school year to ascertain if the pupil is suffering from any 
defect or disability that would prevent the pupil receiving the 
full benefit of the school work or if some modification of the school 
work should be made that the pupil might receive the best educa- 
tional results. 

The medical inspector also shall, at the request of the superin- 
tendent of the school, carefully examine any pupil for evidence 



51 

of infectious or contagious disease or any other condition which 
might prove harmful to other pupils. Whenever any pupil shows 
symptoms of smallpox, chickenpox, measles, scarlet fever, 
tuberculosis, diphtheria, influenza, whooping cough, tonsilitis, 
mumps, scabies, syphilis and other venereal diseases, trachoma or 
any other contagious disease, the pupil must be sent home and 
the boards of health and education notified in writing by 
the medical inspector of schools. Any pupil with any of the 
said diseases cannot attend school. 

The medical inspector of schools also shall carefully examine 
each pupil who has been absent from school for five consecutive 
days for contagious or infectious disease, unless the pupil shall 
present to the superintendent of the school a written or printed 
statement in the form hereinafter given, showing that the pupil 
and the house from which the pupil comes is free from infectious 
or contagious disease, signed by the attending physician and 
endorsed by the medical inspector of schools. 

The medical inspector of schools also shall, when requested 
by the board of education, conduct investigations, furnish in- 
formation and advice and assist to formulate rules of procedure 
on matters pertaining to the lighting, heating, ventilating and 
sanitation of the school buildings; the hours of study, recesses, 
exercises and any other matter pertaining to the health, vitality 
and development of the pupils. And, if deemed necessary, the 
board of education may employ a teacher nurse to investigate 
the sanitary conditions of the pupil and home. 

The medical inspector also shall keep an accurate and com^ 
plete record of each pupil tested and examined in the fol- 
lowing form: 

Date ,191- • 

Pupil Age 

Grade School 

Parent or guardian 

Heart 

Lungs 

Eyes 

Ears 

Throat 

Teeth 

Contagious or Infectious Disease 



52 

Skin Disease 

Special Note 

Recommendation 

Signed , M.D. 

Medical Inspector of School. 

And, when any condition is found which, in the opinion of the 
medical inspector would prevent the pupil receiving the full 
benefit of the school work or would be a symptom of infectious 
or contagious disease, the medical inspector shall notify the 
parent or guardian and the superintendent of the school at- 
tended, using the following form: 

,I9I-- 

The parent or guardian of 

attending School 

is hereby notified that examination of this pupil shows abnormal 
condition of 

Take the pupil to your family physician for treatment and advice 
and take this card with you. 

, M.D. 

Medical Inspector School. 

and on the reverse side shall be printed 

I have this day examined 

of the Grade School 

and find the following condition 

and have advised as follows 



Signed , M.D. 

Dated Physician. 

The physician signing will return card to the pupil who will 
return it to the superintendent of the school attended. 
And, when any pupil shall have been absent from school for 



53 

five consecutive days, statement must be made to the superin- 
tendent of the school attended in the following form: 

Date , 191 • • 

I have this day examined 

of the School 

and find this pupil and the house from which the pupil comes 
to be free from infectious or contagious disease. 

Signed , M.D. 

Approved : , M.D. 

Medical Inspector School. 



Some Publications of the Department of Child 
Hygiene, Russell Sage Foundation 

400 Metropolitan Tower, New York City 



Medical Inspection 

No. 54. The Argument for Medical Inspection and Some Signi- 
ficant Facts 

Hygiene and Health 

No. 71. Open Air Schools. Leonard P. Ayres, Ph.D. 

No. loi. What American Cities are Doing for the Health of 
School Children. (Price 15 cents.) (A Report Sum- 
marizing Conditions in 1038 cities.) 



Medical Inspection of Schools. — Luther H. Gulick, M.D., and Leonard 
P. Ayres, Ph.D. 276 pages. Price, postpaid, $1.00. Charities Pub- 
lication Committee, 105 East 22d Street, New York City. 

Gives in convenient form information about the historical, educa- 
tional, administrative, and legal phases of the work. The most extensive 
bibliography on the subject yet compiled is added. This book has run 
into three editions. 

Open Air Schools. — Leonard P. Ayres, Ph.D. 171 pages. Price $1.20 
(postage 12 cents). Doubleday, Page & Co., New York. 

This volume gives the important and significant American and 
foreign material with respect to outdoor schools. It describes the Eng- 
lish, German and American types, gives the results and furnishes de- 
finite information with respect to clothing, food, cost, administration, 
etc. It has more than 70 pages of illustrations and diagrams. Biblio- 
graphy. 



A leaflet giving full list of printed matter will be mailed on request. 



